Promising and Proven Strategies for State MCH Partnerships
with Academic Colleagues
Laura
Kavanaugh: Thank you. In the
interest of time now, if you have had an opportunity to fill out the cards with
some suggestive topical areas, we can collect those. But also, if you would like to share some successes that you've
had or challenges, opportunities that you've tried to, or you have attempted to
work with in academic health centers; successes that you've had; challenges
that remain, we can open it up for discussion too.
Unidentified
Speaker: (Inaudible).
Unidentified
Speaker: Catalog of best practices, promising practices in maternal and
child health, including children with special health care needs, et
cetera. Key to helping people 2010, the
18 performance measures, et cetera, that's updated regularly. Interactive, local, regional, state; great
idea.
Unidentified
Speaker: And in your spare time--
Unidentified
Speaker: That's a great idea. All
of you have had wonderful successes in working with academic partners, and they
have the same cultural perspective that you do, and time-sensitive needs, and--
Unidentified
Speaker: We want to hear about horror shows. No names named, but, you know, really I think that's one of
things that we're very interested in, and been having discussions with Laura,
with Ann Drum, and other partners, is to help organize further this type of
work, and the bureau is very interested in this issue of both translating, MCH
research, ensuring that it's applied.
They've made huge investments over the years and continue to, as well as
in training and making sure that part of the MCH training investments, or all
of the training investments have yields in terms of the other 85 percent of the
block grant--
Unidentified
Speaker: That's right.
Unidentified
Speaker: --which is you all. And
so in that thinking at Hopkins we are bringing in so more practice-based
faculty, in fact, Cathy Hess is here.
She's going to be joining us part-time in doing some of this work, as
well as Karen Van Landerghem, who has state and national MCH experience. And it's important, I think, to really sort
of hear the horror stories so we can begin to think about, you know, addressing
them so the bureau has some ideas to take back to think about how they work
with centers and researchers in their other endeavors.
Unidentified
Speaker: And there are many activities also that are not only within the
division of research training and education where we try very hard to make this
connection between the training initiatives and research. But I know Michael is in the audience
too. He's had some efforts as well in
MCH-Epi and also in helping practitioners publish journal articles, has been a
recent initiative that Michael has supported as well. And if any of you have other suggestions. I can give you a quick list of a few
training program initiatives that are ongoing right now. You might be active in many of them already,
and if not, they might be ideas. For
example, at the regional level, region four has done regional asthma summits in
connection with both the title five agency and pediatric pulmonary centers, so
the PPCs provide some of the clinical data and translation issues between what
their current research is in pediatric asthma with some of the real public
health issues that are occurring there.
A similar summit was recently held in Florida, also jointly sponsored
with the Environmental Protection Agency.
So there have been some connections there. The schools of public health across the country, University of
Illinois Chicago does regional summits on emerging MCH issues that are
conducted regionally and have some distance-based education efforts associated
with them. There is a Rocky Mountain
Consortium that provides an MCH certificate program within region eight. There are nutrition programs in region nine
that share best practices and nutrition services in region nine as well. So we have some wonderful success stories, but
I came from an academic center before coming to government; I also know about
the difficulties in making those connections as well. So if nothing else, please hear that we're committed to making
those connections happen. We have some
successes but we'd love to hear from you about how we can make further inroads
into those areas. I know everyone's
tired and we're in sort of a dark room now, too. We're there any other comments?
Unidentified
Speaker: I guess one question that comes to mind is who are the school
(inaudible).
Unidentified
Speaker: Right.
Unidentified
Speaker: I don't want to put you on the spot to speak for the bureau but
we're all--
Unidentified
Speaker: That's okay; people do it all the time.
Unidentified
Speaker: We're all (inaudible) increasing accountability and, you know, I
just don't know how the bureau looks at accountability with respect to
(inaudible) training brains.
Unidentified
Speaker: Right.
Unidentified
Speaker: For example, I haven't had a Title V record for a few years--
Unidentified
Speaker: Right.
Unidentified
Speaker: --and I've never asked, but I've never really seen what the
nature of the agreement between--
Unidentified
Speaker: Right.
Unidentified
Speaker: --for example, well, school of public health received the
training grant--
Unidentified
Speaker: Right.
Unidentified
Speaker: --(inaudible).
Unidentified
Speaker: And where are you?
Unidentified
Speaker: Excuse me?
Unidentified
Speaker: Where are you?
Unidentified
Speaker: North Carolina.
Unidentified
Speaker: North Carolina. Our
expectations of the schools of public health training programs that we fund for
the Maternal and Child Health Bureau are that they support leadership
development in their trainees first; that they support some time of faculty
time as well as, so that they have protected time to actually teach and mentor
the students. The performance measures
deal mostly with leadership attainment.
And that is in the field of maternal and child health. So it might not mean that they eventually
are placed in a title five agency, but that they achieve leadership positions
in maternal and child health. So our
measures of success would be leadership.
Unidentified
Speaker: Okay, just to follow up for a second, I think we could have a
broader sense of what you would gain from more (inaudible) or expect in school
of public health--that's very heavily focused, understandably, on the
individuals if they're training--
Unidentified
Speaker: Correct.
Unidentified
Speaker: --who may or may not have been up for some of those positions--
Unidentified
Speaker: Right.
Unidentified
Speaker: --with or without the training they received, but it seems that
the reasonable, given that their (inaudible), their MCH department, their
(inaudible) or have and the bureau still could be interested in helping us convince
those schools that an important part of their mission is to aim for public
health--
Unidentified
Speaker: Absolutely. Let me
clarify. Their primary mission is those
trainees. We're paying them to be a
training program. We also require them
as schools of public health to provide continuing education that is determined
by the state or by the region in which they sit, not solely determined by the
school of public health, and if they provide training and technical assistance
to practitioners, and strongly encourage them that the first cadre of
practitioners that they would link to would be with their Title V agency. If those connections haven't occurred or you
have had difficulty making those occur, give me a call. My phone number, my direct line, is
301-443-2254, or you can send me an email and we can talk about strategies for
making it happen. It happens in some
places easier than others. The cultural
differences sometimes I know even within out portfolio, that some times it
happens and there's been a longstanding connection and then in other areas
they've struggled, or there's been a change of leadership, or--
Unidentified
Speaker: As they say, things turn over.
Unidentified
Speaker: Things change.
Unidentified
Speaker: Yeah.
Unidentified
Speaker: And I don't want to be misunderstood 'cause I think we have a
very good relationship with (inaudible), but I still would take the--what you
were just talking about was still the context of training.
Unidentified
Speaker: Right.
Unidentified
Speaker: I think it's much broader than that.
Unidentified
Speaker: Okay. I'd love to talk
with you further about that. Yes.
Unidentified
Speaker: There's one major concern (inaudible) that they are eager to
publish--
Unidentified
Speaker: Yes.
Unidentified
Speaker: They have to.
Unidentified
Speaker: --and they have to because they don't want let their (inaudible)
and the academy setup is like that. Why
do the same services, it is a service, it's not a public issue driven service
or program, so if there can't be some policy or understanding developed at the
bureau level, that how this can be figured out, but I think that would promote
a lot of collaborations among faculty and the state, because in some cases they
don't want to give the data out, it's internal use.
Unidentified
Speaker: Right.
Unidentified
Speaker: That's very important, and for these certain purposes you can
give to the faculty, but it's not publishable.
Unidentified
Speaker: Right. Director won't
like to publish it.
Unidentified
Speaker: Right.
Unidentified
Speaker: So those type of issues are the practical issues--
Unidentified
Speaker: Right.
Unidentified
Speaker: What sort of policies would make it easier for you to initiate
those sorts of conversations?
Unidentified
Speaker: I think state's departments, they need to be encouraged. Maybe they could be encouraged to publish
the data. There is some resentment at
state level to not to release the data because of certain political
(inaudible).
Unidentified
Speaker: There sure is a lot of resentment, I think, from the people in
the trenches, if the academic folks come in, you've collected the data, you've
done all the work, and then they publish it and nobody ever knows you had a
thing to do with it.
Unidentified
Speaker: Right.
Unidentified
Speaker: And that's not fair. On
the other hand, we often have lots of data and we don't get any support
whatsoever from our directors, as you say, to encourage us to publish it. And that's why I think one of these
initiatives is so valuable where you have people who will help the state people
in the trenches actually bring their data to a publishable thing, and credit
can be shared there. And I think it
would be nice if we could encourage state secretaries of health or commissioners
or whatever to have a little bit more academic outlook and to support and at
least appreciate the efforts of the trenches people to publish. I kind of have to do it surreptitiously, you
know, because it's taking time away from all this administrative stuff, you
know.
Unidentified
Speaker: I was going to say, Laura, what might be helpful from MCHP is
even just setting up some guidelines that if you're going to be working with an
academic center, these are the guidelines you need to think about up front
about publishing. So that you think about
them in the beginning and it is that you end up all the way to the end, and
it's like you're sitting at the state level, the academic institution has done
all this analysis, and then we have to figure out how we're going to get it
cleared through whatever process we had.
Unidentified
Speaker: Right.
Unidentified
Speaker: And so it might be if you could even set up some guidelines that
might be very helpful because they sort of come out from the Federal Government
and, you know, it's sort of like we might go to the academic institution to get
their credentials, but by our coming in and saying these are the guidelines
given to us by MCHB to think about when we're working with academic partners
around publication, it might help smooth part of--
Unidentified
Speaker: And that would facilitate this issue with your directors--
Unidentified
Speaker: It might, yeah.
Unidentified
Speaker: --about availability of providing data; those sorts of things.
Unidentified
Speaker: Providing those come out with negative findings that would
embarrass the government.
Unidentified
Speaker: It's very embarrassing because the bureau as a fundings agency
the state becomes dividing. And then
the other thing is, which bureau will get more of advantage through this system,
you get so many publications now, which is MCH-based on them. There is no name of MCH on those
publications because they are done academically, not through the state,
although state participated in that, they provided the data, but they don't
have the name on it. So--
Unidentified
Speaker: It's a marketing issue as well.
Unidentified
Speaker: --so bureau marketing should be added to those publications.
Unidentified
Speaker: Right, right. So coming
back to some of Susan's issues too about the marketing and so the people are
aware that they agency exists.
Unidentified
Speaker: It does (inaudible).
Unidentified
Speaker: And you have that capacity.
Unidentified
Speaker: Well the--
Unidentified
Speaker: A lot.
Unidentified
Speaker: Right.
Unidentified
Speaker: Yes.
Unidentified
Speaker: Yeah I'd like to (inaudible) what he said because (inaudible) in
our study, most of the problems that we've had, not establishing partnership
with all the schools public health, but more the school of public policy, but it's
been around the end-product, and when we do memorandums of agreement with our
sister agency because we're also state universities and we always get stuck as
to who owns the data--
Unidentified
Speaker: Yes, data ownership.
Unidentified
Speaker: --ownership, who has pre-publication approvals, and that's where
the whole process gets stuck. And in
many instances we can't even come to terms, and the partnership dies as a
result of that, mostly because from the state perspective as well, we want to
have final approval of publications and academics will say well wait a minute,
no, that's and infringement, you know, and--
Unidentified
Speaker: (Inaudible).
Unidentified
Speaker: --academic freedom and in the state they say well no, you know,
we have to make sure that the end result is constant with our policy, you know,
state policy. We're not going to be
publishing something that goes against the Governor's policy, for example. And so we've had many partnerships dissolve
right then and there because we haven't been able to come to--
Unidentified
Speaker: An agreement.
Unidentified
Speaker: Yeah.
Unidentified
Speaker: --an agreement on that.
Unidentified
Speaker: I think this is an important area that actually it would be good
to have at match, and, you know, and vary the *LEN programs and the MCH
programs to have some focused brainstorming discussion around. I think, you know, that alone is interesting
because there are times when we've actually had said to the state well, you
know, it may be to your benefit to not have the right of final approval because
it may be that some things need to be said that you can't say. So it gets just sort of all these--there's
so many different angles, but I think you raise a really good point to not only
is there the issue of clearance in the government agencies, but then, I'm sure
you know, the journals and, you know, whether they will publish something
that's already been put in a brief or a handout. You know, I have to tell you I'd walk around in a flak jacket if
that--a fact sheet, and you know, don't do it in just such a way to no preclude
my colleagues who worked with me on a project to get something published, you
know. And so, you know, there are a lot
of issues that I think may be, a few different experimentation we can maybe
clarify.
Unidentified
Speaker: You know, it's no so much got us at the MCH level--
Unidentified
Speaker: Right, yeah.
Unidentified
Speaker: --it, you know, whenever we--
Unidentified
Speaker: Right.
Unidentified
Speaker: --do these memorandums of agreement--the lawyers get a hold of
them.
Unidentified
Speaker: Yep.
Unidentified
Speaker: And it's at that level--
Unidentified
Speaker: Right.
Unidentified
Speaker: --that the discussion sort of stalls because it's at the legal
regulatory level that the state, on the state's side, but the lawyer says well
no wait a minute--
Unidentified
Speaker: Right.
Unidentified
Speaker: --this has to go in it.
And then the academic side will say well wait a minute, this is
infringing our academic freedom and--
Unidentified
Speaker: Right.
Unidentified
Speaker: --so it's not really at the program level.
Unidentified
Speaker: Right.
Unidentified
Speaker: I think we can come to terms very easily as to how we're going to
make those arrangements, but that (inaudible) and it goes to another level, the
regulatory level--
Unidentified
Speaker: Right.
Unidentified
Speaker: --and that's where it seems to stall.
Unidentified
Speaker: Please join me in thanking the panel for the presentation, and
thank you all for your local community.
Unidentified Speaker: Thank you,
ladies.